Myocardial Infarction

Question 1

All acute coronary syndromes are lead by….

Answer 1

Spontaneous plaque rupture

Question 2

In STEMI the artery is…

Answer 2

completely blocked off

Question 3

Symptoms of MI

Answer 3

Severe crushing chest pain radiating to the jaw and arms especially the left- the pain is similar to angina but not relieved by GTN. It is associated with sweating, nausea and pallor. Patient likely to use hand gestures to describe pain.

Question 4

ECG in STEMI?

Answer 4

ST elevation

T wave inversion

Question 5

Enzymes in myocardial infarction?

Answer 5

Often don’t have time to wait for these

CK (creatine kinase) peaks after 24hrs
Troponin detects cardiac necrosis even small amounts peaks between 4 and 6hrs however troponin can be released from the heart in other conditions.

All tests interpreted in context.

Question 6

Early Treatment of STEMI?

Answer 6

Analgesia- diamorphine
Antiemetic
Antiplatelets- aspirin (300mg) and ticagrelor (180mg) or clopidogrel instead of ticagrelor
GTN if blood pressure more than 90
Oxygen if patient hypoxic
If patient is more than 2hrs from hospital they are given thrombolysis therapy if less than 2hrs patient prepped for PCI and taken to hospital.

Question 7

Drugs for secondary prevention of MI?

Answer 7

Aspirin with ticagrelor/clopidogrel for 3-12 months, statins lifelong, ACE inhibitors, Beta blockers, GTN spray as required.

Question 8

In NSTEMI the artery is…

Answer 8

narrowed but not fully occluded

Question 9

The difference between UA and NSTEMI is

Answer 9

NSTEMI has an occluding thrombus that leads to myocardial necrosis and a rise in serum troponin or CK

Question 10

Treatment of NSTEMI?

Answer 10

Still want patients on dual anti-platelet therapy. Want to inhibit the coagulation cascade- block factor 10- heparin/ fondaparinux. Group 2B3A inhibitors.